Preoperative bathing or showering with skin antiseptics to prevent surgical site infection

Abstract

Background
Surgical site infections are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection.
Objectives
To review the evidence for preoperative bathing or showering with antiseptics for the prevention of hospital-acquired (nosocomial) surgical site infection.
Search strategy
We searched the Cochrane Wounds Group Specialised Register (21 July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (January 1985 to September 2004) and reference lists of articles.
Selection criteria
Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in patients undergoing surgery.
Data collection & analysis
Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results
Six trials involving a total of 10,007 participants were included. Three of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub). Three trials involving 7691 participants compared this antiseptic with a placebo. Bathing with chlorhexidine compared to a placebo did not result in a statistically significant reduction in the surgical site wound infection rate; the relative risk (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). Three trials of 1443 participants compared bar soap with chlorhexidine. When results of the three trials were combined no differences were detected, the RR was 1.02 (95% CI 0.57 to 1.84). Two trials of 1042 patients compared bathing with chlorhexidine with no washing. No difference was found in the postoperative surgical site wound infection rate between patients who washed with chlorhexidine compared with patients who did not wash preoperatively, the RR was 0.36 (95% CI 0.17 to 0.79).

Reviewers' conclusions
Washing preoperatively with chlorhexidine offers no benefit over placebo or bar soap in preventing surgical site wound infection.

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The review, when published, supercedes the Protocol which is published as:
Webster J, Osborne S. Pre-operative bathing or showering with skin antiseptics to reduce surgical site infection. (Protocol) The Cochrane Database of Systematic Reviews 2004, Issue 4.